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HomeMy WebLinkAbout17136-z v-.. FORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Office of the Building Inspector Town Ha11 Southold, N.Y. CERTIFICATE OF OCCUPANCY No Z-20213 Date SEPTEMBER 12, 1991 THIS CERTIFIES that the building ACCESSORY Location of Property 590 SILVER COLT ROAD CUTCHOGUE N.Y. House No. Street Hamlet County Tax Map No. 1000 Section 95 Block 4 Lot 18.36 Subdivision OREGON VIEW ESTS. Filed Map No. 6241 Lot No. 36 conforms substantially to the Application for Building Permit heretofore filed in this office dated JUNE 14, 1988 pursuant to which Building Permit No. 17136-Z dated JUNE 20 1988 was issued, and conforms to all of the requirements of the applicable provisions of the law. The occupancy for which this certificate is issued is ACCESSORY ABOVE GROUND SWIMMING POOL WITH FENCE ENCLOSURE AS APPLIED FOR• The certificate is issued to ALFRED W. & JOYCE A. STEINER (owners) of the aforesaid building. SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL N/A UNDERWRITERS CERTIFICATE N0. N-201460 - AUGUST 26 1991 PLUMBERS CERTIFICATION DATED N/A Building In ector Rev. 1/81 Fosa>t xo. s TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, N. Y. BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) N o 01713 6 Z Dote 19.Fs.,/J Permission is hereb ronted to: / to ,r~.ps.... ...............:~ieCG.~~......~ ct premises located of ........7..17....°.'.`.:7.. .srt..7.....~~F~ .................................................~~~,~.4~%.......................................................................... County Tax Map No. 1000 Section Block Lot No......~~.~..~7... pursuant to application dated .....>!P..~,~~ 19.G~~ and approved by the Building Inspector. n® Fee ~ t..~ ding inspect r Rav. 6/30/80 I et'" " J TOWN OF SOIITHOLD ~d,fi,~ f. , i ~~(p BIIILDING DEPARTMENT ~~E ~ ~ ;I' ~~3 yy 81968 ~ F ~ TOWN HALL U~ ~ ~ I t3P -•.......a; ~~r t. ~j SOUTflOLD, NEW YORR 1 197 1 TplrUf~~y~SC L~~h<" i 765 - 1802 APPLICATION FOR CERTIFICATE OF OCCIIPANCY DATE. Au~ust.7,• 1989. • Above ground pool NEW CONSTRUCTION ...X...OLD OR PRE-E%ISTING BUILDING......VACANT LAND........ Location of Property.. 590 Silver•Colt_Road,•Cutchogue_..._.•_••._••••.•..••.••..• . HOUSE NO. STREET HAMLET Owner or Owners of Property. (MY: Mrs Alfred. &•Joyce •Steiner • • . • • • _ • . • • • • _ • - County Taz Map No. 1000 Section 95... Block .04.... Lot 18:36••• Subdivision.,•Ore~on•View Estates..•_ giled Map 6241 ....Lot.. 36...... Permit No. •171362 6/20(88 Alfred W & Joyce A. Steiner ....Date of Permit ..........Applicant To follow Health Dept. Approval Underwriters Approval.............. Planning Board Approval Request for Temporary Certificate Final Certificate ..X /,.~/y6 ~~34, Pee S:jhmitted: $?5,40. V...... ......ns ~ APPLICANT... oy e A. Steiner Q.~•y~sgs rev. 10/14/88 co~ao~i ~ o SEp 91991 BLDG.DEpT: TOWN OFSOUTHOLD 590 Silver Colt Road Cutchogue, N.Y. 11935 September 6, 1991 Attention: Helen Town of Southold Building Department Town Hall - Main Road Southold, New York 11971 Re: Permit~117136Z - Above Ground Pool Dear Helen: In accordance with our telephone conversation today, enclosed is our check for $25.00. I understand that you have a copy of the Underwriter"s Certificate and our application in your file. Please issue a Certificate of Occupancy at your convenience. Thank you very much for your patience and understanding in this matter. Sincerely yours, /j as Joy A Steiner THE NEW YORK BOARD OF FIRE UNDERWRITERS ,I°~f,~, iC;uli i%F; BUREAU OF ELECTRICITY 85 JOHN STREET, NEW YORK, NEW YORK 10038 Date I!U(a6T 'ih; la'}i Applic¢tion No. on fide of"'~'~``I't f}~5 ,/;;~J ,u ~;i19 ~,#*t} THIS CERTIFIES THAT only the electrical equipment as described below and introduced 6y the applicant nomad on the shove ¢pplicatlon number in the premises of dC1YCN; d'L fhl fi'CF;CDI151t; 'a0[l SIIIitU,Fi CQs.`.i' Itii_r t1dP1"CF4i1fsUP~r 6L,Y. QQ.i'}` in the following Inration: ? B¢.vement ? Ist F'1. ? 2nd F1. .Section Blork Lot uas examined on and found to 6e in compliance with the requirerrzerzts o(th[s Board• FIXTURE ECEPTACLES SWITCHES FIXTURES RANGES COOKING DECKS OVENS DISH WASHERS EXHAUST FANS OUTLETS INCANDESCENT FIUORESCENi OTHER PMi K W AMi K.W. AMi KW. AMi K.W. AML H P I DRYERS FURNACE MOTORS FUTURE APPLIANCE FEEDERS SPECIAL REC'PT TIME CLOCKS BELL UNIT HEATERS MULTI-OUTLET DIMMERS AMT K W Oll H P GA$ H. P. AMT NO A. W G AMi. AMP AMT AMPS TRANS. AMT H p SYSTEMS pMi WAiiS NO.OF FEET s 1L3 SERVICE DISCONNECT NO.OF $ E R V I C E PMi AMP LYPE METER L RW I ~ JW 3 ~ JW 3,e 4W NO. OF CC CONp. A W. G NO. Of HI-LEG A' W. G NO Of NEUTRALS A W. C° EQUIP. PER A' Of CC COND. OF HbLEG OF NEUTRAL OTNF.R APPD.RATUS: SW7.hiP1s.6fG PLIaL-~ srlra:~~a~l a~,rr'I~l,c7.;~;~; + ;h/f,., ..l x~. G. n (`iH i:F4.t4'tNG PfKH,) '±'TI ~ s rta° P'i. l" a CB~F, t• rpVa~r^. r~nm)n~li ~ne~f: a. taLe~ Ltc'r„ «~t i tlsx lxr L7t~i nll t>ltly. tt,.~l 3Ut~l~ or un~s+,ta i. ' _rily jt,l YtlllttlPJi i.v ,r l I nQi V'L y:Ri9f tal hBVra tY'rtfdUAll i; I'Ffi` tTCtL'i J'nl' ["4~T58'!L"i~ rnadF Ilg zi tynnl.~t-ieu' iurLr;t~il, ~ ~~z:E-ceve.~ ti'I;N;NFI'S 1?t~F,(:/Ri,AL7tN.T{'L':dp{'a ...C,{)'th9,1-MI Y.t). R0~ 7 2G£3 GENERAL MANAGER 56U`t'Cia[,rl, Ivy, 2.1u"7'l. Perl ;1 s This certificate must not be altered in any manner; return to the office of the Board if incorrect. Inspectors may be identified by their credentials. COPY FOR BUILDING DEPARTMENT. THIS COPY OF CERTIFICATE MUST NOT BE ALTERED IN ANY MANNER. i (NS~ CTORS o~OSUFFO(,~~0 516 765-1802 ~ G,y SCOTTL.HARRIS Su ervisor VICTOR LESSARD, Principal = ` p CLIRTIS HORTON, Senior y Southold Town Hall VINCENT R. WIECZOREK, Ordinance p • ~ P.O. Box 1179, 53095 Main Road ROBERT FISHER, Assistant Fire Southold, New York 11971 Buildin Ins ectors 'h0,~ .~0 Fax (516) 765-1823 B P ~ Telephone (516) 765-1800 THOMAS FISHER GARY FISH OFFICE OF BUILDING INSPECTOR TOWN OF SOUTHOLD February 28, 1991 Alfred & Joyce Steiner 590 Silver Colt Rd. Cutchogue, N.Y. 11935 Re: B.P. 171362 POOL WITH FENCE ENCLOSURE June 20, 1988 Dear Mr. & Mrs. Steiner: On July 17, 1989 an Order to Remedy was issued to you regarding the above permit. Since then we have notified you on 3 occasions that your permit has expired and you have not obtained a Certficate of Occupancy. This will be the last letter. Please comply by taking care of this matter. You need an underwriters certificate and an application and your check for $25.00. Yours truly, Secretary FOItSI NO. 5 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. ORDER TO REMEDY VIOLATION Date July... ~ 1989.... Alfred & Joyce Steiner TO . (owner or authorized agent of owner) 590 Silver Colt Rd. Cutchogue, New York 11935 (address of owner or authorized agent of owner) PLEASE TAKE NOTICE there exists a vialaticn of: Zoning Ordinance CHAP. 100 Other Applicable Laws, Ordinances•or Regulations of premises hereinafter described in that A swii®ing pool is being used without a (state character of violation) Certificate of Occupancy and an expired building pernit. in violation of ARTICLE XXVZII-Chap. 100-281 6 284. (State section or paragraph of applicable law, ordinance or regulation) YOU ARE THEREFORE DIRECTED AND ORDERED to comply with the law and to remedy the conditions above mentioned IMMEDIATELY The premises to which this ORDER TO REMEDY VIOLATION refers ore situated at 590 Silver Colt Road, Cutchogue County of Suffolk, New York. SUFFOLK COUNTY TAX MAP 1000-95-04-18.36 Failure to remedy the conditions aforesaid and to comply with the applicable provisions of low may constitute an offense punishable by fine or imprisonment or both. Building Permit /117136-Z gg i~ ~~pp , n') ORDINANCE INSPOR VINCENT R. WIECZOREK (Cert. Mail) ~A''L3~, TEL. GS-18D1 / ~ To~rrr or souTUO~.o i'''lr2jE;~~r.~ OPi'TCL' OC DUILDIiv'G INSPECTOR u' '~.r=d1„!~~l'~ ~ TOWN 11ALL «•''c',y,, SOU7~ilOLD, N.Y. 1 1971 .~~Q!• . - a~ t ~ 9 y ~u~-z-~~ , 3~. ~ . f I q 3s 'Po t•7hcm This May Concern, 4;e are unable r.o complete your Certificate of~Occupancl~ because of the folloc•~ing reasons. An application for Certificate of Occupancy / is not on fi].c. ~L / ~ *to Under~•~riters Certificate on file. 't'he chr_cF: .i:; (-^~,~nut on file.) ~ a5~0'fl P!o Ilcal.th Dept. Approval on file. P:o final inspection has been made. Ploasr. contact our office on this matter. - Thatck you for your cooperation. tluilclieg Pcrm.it•. p ~ ~ ~ Z Duilclinq Dupt. Uo Plumber :;older Certificate on file. ( all permit:: involving plumbing being issued after ,1pri1 1,1984 ) A,,II~FD" ~'~4• TEL. ?GS-IE~'_ `05,;,.~.~ ~o-~ ~ To~~rr .or souTUO~.~ (a~?~~~,~r;~ or•l~tcl: ar• ~ultDl;vc tlvsrECroa ,rte; ~ TOWN I IA LL ' ~Ol SDi1T1IOI_D, N.Y. 1 1971 101,3 I 9 ~ 90 met R d. - To Dlhcm This May Concern, D7e arc unable r.o complete your Certificate of Occunancy because of the following reasons. An application for Certificate of Occupancy is not nn fil.c. *Io tlnderwritcrs Q:rtificate on file / / 't'he chcct: .i:; (rnitdated/nut on file. ) D:o 1k.al.th Dept. Approval on file. t•:o final inspection has been made. Please r_ontact: our office on thin matter. - Thank you for your cooperation. Pii.ildirg Pcrm.it: U 1 7 ~ ~ ~ Z Duildinq nupt. . tt*/_/ tlo Plumber Solder Cert.ificatc on L-ile. ( al.l permits involving plumbing being .issued after April 1,1984 ) a 1713 G ~ 'ss-iso2 P~ BUILDING DEPT. INSPECTION [ ]FOUNDATION 1ST [ ] ROUGH PLBG. [ ]FOUNDATION 2ND [ ]INSULATION [ ]FRAMING [FINAL REMARKS: - ® ~ c DATE~~' ~ INSPECTOR ~ _a -1ELD I.:SPEC;iU.+ ~~UA.-TE ~I i;Oa~iMENT° ~ -o 1. ~ 3 ~~1 - - ~3 l ~ FOUtJDATION (1st) N o FOUNDATIOtJ ( 2nd ) _ - m~ ~ 2. o`~ ROUGH FRAME & ~ PLUMBING H 3. m IIJSULATIOP] PER N. Y. ~ STATE ENERGY \ CODE FINAL ADDITIONAL COMMENTS: ~ ro ~ .~~N ~ y t-~ O z x ro a~ • r H - x d cn .D H CC PNCY O ~~~IVIMEDIATELY" ENCLOSE POOL TO CODE T8~ A9S 28 !r'W 10 23 ~ UPON COMPLETION BEFORE "WATER" ~T OUT CET TE o ~ _o O~ CCUPACY ~ ~ q ~0. P •OJr ~~i k 'i Pcrt 9 9~9„ < `'mss p~~~ /`~a'pA1 ~o• ,y ~ ~ F" a J Y~/ / a. v / ~ boll E ` ~ ~^~a D P~~ 'IMMEDIATELY' W~ ~ L~?' ~ 0~0 ENUPONECOMPLTE'OTIONDE Na ~ y9' DQ~~ BEFORE "WATER" ~ 11~~t~"D*,i ' - ~A~ / o Q / % D ~0 io.EOS' i 4e ~1 F4y ' e p J,~J srL vER A.,~~ Js. F fu / ~ ~ Y3 II~~ R,~, o ~OfT qqN~. a ~:°oo ¢NCLO$ ~DI^i I ~ ar N 00 T., a rJ B OR ~ ~d~7~R ~ DE "fDo 90 . -t~EN2 SURVEY fOR AUE /o, /a!1 SUPTDLL JDONTY xzAC"'' ALFRED W. STE/NERB ?OYCE d. STE/NER .NINE /Y, /aa1 ~AUG 2 81984 t, _ l3 so /94 AvavL a,/aa~ DASE__ _ _ . ~ • LOT 36, °OREGON V/EW ESTATES° YARCM 2$ laM AT CUTCNOGUE oarL ocr. /aaJ The Sex.a ~ '"D''Y TOWN Of SOUTNOLO SCALC /':ap. faclltu•y seen N0. al-aji ..,ype SUffOIK COUNTY, NEW YORK tneDnct~~' I 4. Yom. •o !e ^,xU-:: c'-ct Y•~~?`'~ ~a ~ .ururxan2te {LrwnaN O(fooinoN n Txn GUAFANTEED TO' +u.un o. vroLAnoN v KcnoN tto{ v rxt CRICA60 oW ~E CO. K~ rONa nag aoucfTia w ' Chief of Genr-^: in ~ineering Ncanfv nos fulvn MOT KNN+If Txt uxo 504 PS wMtrN'f WKO KNL of tnwuD K.L wuL ~S,T,D W, ~ fe Ser: aeD Nor K cwfiewo To K. vum roue corn O • WMMYTUf W WCNT20 KKON 11WLL NN OILY A ro c NEKiN DLMRTMENT -DATA f0P APGgDJII 10 CENSTNUCT TIW wNwN row ~IWIT rx[ wNV[T n n+ruw _ 1W1 a Nf KMfN TO M nrL[ CCYMIIT,fOW1N• NII[IN[fTNIp WN~SN.'1l wuNt[Ol 9+TM~TNWTa~ IC. N[MTML AKMCT AMO llNOwf WfTITVTION 4fT[f O}I/Oe TK IIV MT,o_o NCTrM Off wA211~L01 ~..w xOI[O'. YO TO TN[{SfWIIK20I Mt L2N01M N TNTt YI[ IN O>•[LLMWf tITWM ro0 I[R M TMf MOT[NTr WfTIIYTWl1. WK1NKn M! MDT T11Wa[NM[Ll nl MtgnOMML rnITYTMWf 011 n(KW[Y1 erNa TxMN TxOK fxow xu[oN owa+ ~ 'h '~a_ AsTls3- - ¦TM aonN twwTAlp s[WaK afIK+?fnru TON TNr TNO+eaNU NmmfKn fxfeM NfKM rNON TwoluT. uxu fIN1 i0NI0M A TMl a1N0M6. OI TK fr10.N COYxi• 04MTNMT Tp2fIfTWf {TNVCIDNtf MI IM I1 P[tlIIC W M[AL5'x fpNIC[L NRrof2 .aNf AN6 MOT T9 K YrtO TD tltULI+I1 IAk4 .eRMOC yKicy,T, WWIINT LIN[f ON NA nH GtCiIOM v I[MCO rNw[w ,<L. YOUNG 8 YOUNG ~~vER~i~E'"wo"", N~~w mA E ¦~AlONY/A/EM ALDEN W.YOUNO, PIIOFESSi0N4 EM61N[ER .1TAT'I'OLKLW/ ~ ~ ~~ERA'Of' ANp W10 SIMVEYOg M Y.S.UCEMSL NO.ILgA3 'IOWAIID W. YOUNO, U1N0 SUIIVEYOA Mt~1110~jN1liwMtA fNW~ANO M(MO OtTN~iWa~IN01Tl~[N~a N.Y. S. LICEMS[ NO.ASgg3 m 0 'FORM NO. 1 TOWN OF SOUTHOLD III f ~ ~8B BUILDING DEPARTMENT TOWN HALL BIOG. oEar. PiOUTHOLD, N.Y. 11971 iOWNOFSOUTHO TEL.: 765-1802 Examined.%~~•••••••••,19~~ Received...........,19... Approved • • • • • • 19~Permit No. ~ Disapproved a~/c . (Bull ing In ctor) APPLl~ATION FOR BUILDING PERMIT Date .....~'3'J4'N.?-.I.?~, 1~$.. INSTRUCTIONS a. This application must be completely filled in by typewriter or in ink and submitted to the Building Inspector, with 3 sets of plans, accurate plot plan to scale. Fee according to schedule. b. Plot plan showing location of lot and of buildings on premises, relationship to adjoining premises or public streets or azeas, and giving a detailed description of layout of property must be drawn on the diagram which is part of this appli- cation. c. The work covered by this application may not be commenced before issuance of Building Permit. d. Upon approval of this application, the Building Inspector will issued a Building Permit to the applicant. Such permit shall be kept~on the premises available for inspection throughout the work. e. No bullding'sHall be occupied or used in whole or in part for arl};,purposg Wliafeyer until a Certificate of Occupancy shall have been grxrifed by the Building Inspector. APPLICATION IS HEREBY MADE to the Building Department for the'issuance of a Building Permit pursuant to the Building Zone Ordinance of the Town of Southold, Suffolk County, New York, and other applicable Laws, Ordinances or Regulations, for the construction of buildings, additions or alterations, or for removal ' ' in described. The applicant agrees to comply with all applicable laws, ordinances, building code, housmg co e~ an, regu ations, and to _ _ eriz?d in~nrrtars on premises and in building for necessary, inspectjpns ~~ar°r! a Vimit a.~th - f//T/ ~ 3~, 4) (Signat of . , • • ~4ia~ . . Alfred W. Stei 5$Q.St.7.~tet.Gv1 agu !,#.1.... (Ma m r# ~ r b der. State whether applicant is owner, lessee, agent, architect, engineer, general contractor, a e#ctrician, e~p,: 4 ~'}^ti~+d0~"3llal`i'r;b7rl:F ia~s_ Owner .......................................9y..yi.~~.... f3.;3~a~ 3' #.4'?}:,SSM9 • ~U~YY~ .1J.~~`~~" ~',v~15 ~,~i~~{~~{~ik~.4 Name of owner of premises .Alfred W. & Joyce A.• ,Steiner , , , , , , , , , • • , v 45 . ~tdt . ~~y..,,~~,-3~.1 Fyn;. ~X?'1~? . • . • • • • • (as on the tax roll or lat , ),R F~~sr'~~9f13'~'U",~' • q ~ ?l,~ti?E~t1t r+'.;..*2i ri ii,+ If applicant is a corporation, signature of duly authorized officer. ,~testia'a 4$, ;t g-,~ . , . ccu (Name and title of corporate officer) Builder's License No. ..t~'4~?:1t-4~+~ Plumber's License No . A~~~~~ ~ Tl~~T~ Electrician's License No . ~,,a Other Trade's License No . . 1. Location of land on which proposed work will be done . . ...590.......Silver, Colt, Road ............................Cutchogue....... House Number Street Hamlet County Tax Map No. 1000 Section ......95 , • • • . , • . , . Block 4 Lot 18.36, , , , , , , , , , , Subdivision ..Oregon View ,Estates . . . . . Filed Map No. ,6.2.4.7, , Lot 3,6........ . (Name) 2. State existing use and occupancy of premises and intended use and occupancy of proposed construction: a. Existing use and occupancy ,Residence iA.t t~i~ja3i • ~iA°++viYt M rsr ark ,zd:~u'6 b. Intended use and occupancy ,Same ti„~v{{,. , ?t ; , , , , , , , , , , ~ss~.a~ n8 , , , , , , , , , , , , , , , , et wail 1 flD1 3. Nature of work (check which ap',plicable): New Building Ad , ~.-'C . Repair Removal Demolition O~thpr,WQrk . gxounrl, ,ppo, YYY 11 f1~~rr scription) 4. Estimated Cost ~3Do: oo ,i Fee . . (to b id' bn fi iT ,t ' a cation ~4R~., I ~ .~f ,PP ) 5. If dwelling, number of dwelling Units . Number of dwel mg units on each floor . I1.' garage, number of cars . 6. I1' business, commercial or mixed occupancy, specify nature and extent of each type of use . 7. Dimensions of existing structures, if any: Front Rear Depth . Height ...............Number of Stories.........,.................................,............ Dimensions of same structure with alterations or additions: Front . Rear , . Depth .Height ......................Number of Stories . ' 8. Dimensions of entire new construction: Front Rear ...............Depth . Height . Nurq'ber of Stories . 9. Size of lot: Front . 9,Q' Rear ..?45 ~ Depth 317' North. 231 South 10. Date of Purchase ,4%16%84 , , ' , , , , , , , , , , , , , Name of Former Owner Thomas. virginia• Harris• , . . 11. Zone or use district in which premises are situated ,Residential 12. Does proposed construction violate any zoning law, ordinance or regulation: .No . 13. Will lot be regraded ...NQ .......................Will excess fill be removed from premises: Yes No 14. Name of Owner of premises .A7,i;zGd Seiner wf Address 590 ,Silver Colt, Rd., phone No. 734-7043, , , , , , , Name of Architect ................Address ,Phone No............... . Name of Contractor ................Address ...................Phone No............... . PLOT DIAGRAM Locate cleazly and distinctly all I buildings, whether existing or proposed, and, indicate all set-back dimensions from property lines. Give street and block number or description according to deed, and show street names and indicate whether interior or comer lot. „?M,M~p'gTELY„ "IMMEDIATEI.Y`° ENr~I-(3r pOOI T ENCLOSE POOL TO CODE UPt3(y COtL^ln! rO CODE UPON COMPLETION BEFORE -°'TION BEFORE "WATER" WFaTC.~;•• a~ NOD oATE: IIJt N ~ ay 3 FIEF: wd. NOTI AT 7188-1iDS ! AM 10 4 PM NOl1 '17HE FOLLOWING M18?iC71pN8: i 1. FOUNpWBQN 1MR1lp ~ w FdIt1~Q1111/pQpN~ i ~ s 2. RQUGi1 • NIAMINO !'LAJwA~NG y ` ~ ~ 8. 1NSUI.ATILiN M ~ , ` ` ~~i i 4. FINAL - CONSTRUCTION MUST ~ ~ ' °p ~y/ ~ BE COMPLETE FOR C.O. ~ . ~ ~ iaa ALL CONSTRUCTION SNAIL MEET ~ - ~ ~ ~ ~ r THE REQUIREMENTS QF THE N.Y. ao. ~b.-~E`__ / ~ ey S'rarE CONSTRUC`f10N 8 @NEhGV ~ ,s oRy CODES. NOT RESPONSI9LE FOR a ` y ~ / e o Di~SIGN OR CONSTRUCTION ERRQRS ~ ~ r . ~ ~s n,~ ~ ~ ~ OF NEW YORK, ,r'«~2 sy t~~ COUP / J~~ N'CY OF . suFFOLx), , , , • , , S.S c,~ sy ALFRED W. STEINER ~ • • • • • • • • • • • • • • g ~ • • • • • . • • being duly sworn, deposes and says that he is the applicant (Name of individual si Wing contract) above named. He is the Owner (Contractor, agent, corporate officer, etc.) of said owner or owners, and is duly authorized to perform or have performed the said work and to make and file this application; that all statements contained in this application are true to the best of his knowledge and belief; and that the work will be performed in the manner, set forth in the application filed therewith. Sworn 'to before me this ~ y .{..........day of I..~lA~!l4 19~~ Not$ry Py,1b{1ilc.... , , ,SUFFOLK• , , , , County (Signature of applicant)